The President's Emergency Plan for AIDS Relief, established by former President Bush to fight HIV/AIDS in Africa, has been widely acclaimed for its success in distributing antiretroviral treatment over the past five years to more than 2 million people suffering from the disease. Now that there has been a change in the White House, those familiar with PEPFAR are wondering what the future holds for the fight against AIDS, especially since the program no longer has a director 

Dr. Mark Dybul, PEPFAR's architect, was part of the Bush administration, so like most other political appointees, he expected to leave when Bush left. At first, President Obama asked Dybul to remain in charge of the program until another director could be found. However, soon after he took office, Obama asked Dybul to resign with little explanation. 

Kay Warren, wife of Pastor Rick Warren, and Elizabeth Styffe serve as directors of Saddleback Church's AIDS initiative, and the two women discussed with me the future of programs like PEPFAR and what Christians have done right and wrong in this work. Though the Lake Forest, Calif., church is not directly involved with PEPFAR, both women are familiar with the program because of their own involvement in the AIDS crisis. 

On Dybul's departure, Kay Warren said, "Of course the administration had every right to appoint a new person. What is the issue is how abruptly he was asked. I don't have any insight to that. . . . [Dybul] was competent, he was very passionate about what he did. I have every confidence the Obama administration will pick the right person. 

"We definitely still believe in PEPFAR, even if some of the things I care very much about change," she continued. "I'm not going to pull my support from it because I believe in its basic overall goals." 

In commenting on one change-President Obama's repeal of the Mexico City Policy, which had prohibited grantees in receipt of U.S. funding from performing abortions, lobbying to legalize abortion, or promoting abortion as a family-planning method-Warren said, "That's a worldview issue . . . I don't agree with. There will be some battles about sexuality, family planning. There are a lot of things that are going to be different." 

As for PEPFAR, the Bush administration brought a new approach to the AIDS fight by incorporating local churches as part of the distribution for medications and education-an approach that Warren hopes will not change. 

"The church is finally in many ways able to be part of the equation," Warren said. "Faith-based organizations are able to contribute and be a part of it. It's not perfect, no program ever is, but it's done more to address the problem of HIV than the U.S. has ever done in any program. It made it seem possible that we could make a dent in this epidemic that spanned the globe." 

Styffe added, "It's pretty controversial. We don't just dump our money into the pot that the rest of the world is dumping its money into." 

Some activists have said that the faith-based approach emphasizes abstinence, letting contraceptive measures fall by the wayside. 

"We are not anti-condom," Warren said, "it just includes the worldview that people can be responsible in their sexuality." 

"People need to not think that PEPFAR is this Christian thing," said Styffe, adding that the program is the No. 1 supplier of condoms around the world. 

Christian organizations didn't escape criticism from the two women for their approaches to the crisis. Styffe said in past years she would ask Christian groups in Africa if antiretroviral drugs were part of their approach to combating AIDS, and often the response would be "no." 

"We have a moral mandate," Styffe said about offering medicine to those with AIDS. "God by his grace has made treatment available to people." 

Warren agreed: "It doesn't matter how someone became HIV-positive. At the end of the day, Jesus never asked how anybody became sick, he just said, 'How can I help you?'" 

"I hope believers would see that PEPFAR is a way to collaborate with the church," added Styffe. "It's not PEPFAR verses the church. When you're talking about the greatest pandemic of all time, you need government, business, and the church. 

"Our ultimate confidence is not in PEPFAR," Styffe concluded. "It is in the local church everywhere."